1 nurse for 30-35 residents??

[1st edition]

I started a new job at a LTC facility last week. Starting tomorrow we will only have 3 nurses per shift. Which means each nurse will have 30-35 residents to care for a piece! Has anyone else ever worked at a LTC where the nurse - pt ratio was so horrible? I feel this is a mistake waiting to happen. Someone will get hurt, or neglected to death, and a good nurse will lose her license. I go on the floor by myself tomorrow too. Yikes!!! This is not good care. It can't be. We will have time to THROW the meds at each rsd. We won't have time to say "boo!" much less do a proper assessment on these poor people!

[TheCommuter, BSN, RN]

30 to 35 residents per nurse is a very typical ratio in LTC. You simply will need to learn to manage your time very well. My friend is an LTC nurse who has 55 residents to care for. LTC nurses tend to have many residents to care for because these patients are usually in stable condition and don't need daily head-to-toe assessments.

[1st edition]

I have had 54 rsd to care for but that was on graveyard shift. This is on 1st and 2nd shifts. This is my 4th LTC facility to work at and I have never seen day/evening shift have so many to care for but I will certainly keep your post in my mind tomorrow. I will repeat all day long like a mantra, "This is not unusual just need to manage my time". Hopefully, I can learn. If this is the norm then I'll deal, I geuss.

[TheCommuter, BSN, RN]

My friend, the one with 55 residents to care for, works the 2-10pm shift.

[dekatn]

Like Commuter said, most of these residents are stable and don't require head to toe assessments. Once you get used to your residents, you will be able to tell a lot of times, just by the way they look or act, that something isn't quite right, then you would investigate further. This too, is where your CNA's will be your right hand. They do the hands on care and will advise you if something isn't right. If they have a bruise, edema, or they are just not acting right, your CNA's are your lifeline and will let you know. You will still have your weekly, medicare and MDS charting to do each shift or incident charting, on these residents you will want to do a more thorough assessment, but there is no way that you can do your med pass, charting and wound care and still do assessments on all your residents. Just give it time, you will learn your residents, I know it's hard at first, but LTC is a whole different ballgame compared to school and hospital environments. When you get your meds downpat, who gets crushed with what and when, you will have won over half the battle!! Try to keep your meds in the order they are given in the drawer, this will save a lot of time also, you will be able to pick them up and look at them a lot quicker and not have to search the drawer back and forth looking for certain meds. I know 35 residents sounds like a lot, and it is, but it is typical for LTC to have that many and as some posters have stated, even more. Don't be too hard on yourself this too shall pass!! I think all of us that work LTC have felt the same as you do right now. It does get easier over time. If I can help in any way please let me know.

[BabyRN2Be]

I'm sure that you will have CNA's working with you, who will be your eyes and ears when you can't be there. As other people have said, LTC is different from hospital care. You won't have to do head to toe assessments every day on every resident from what I've seen.

Hopefully you will have a great group of CNA's who will help you identify those who need attention.

Best of luck to you! I hope it goes well. :)

[1st edition]

Thx for the support guys! I'll let u know how tomorrow goes. I've never worked any shift except graves so this is all new and I am terrified!

[Midwest4me]

That kind of ratio is very normal for LTC....I worked many LTCs(in search of one without those horrible ratios) and found that ratio in every single one. Unless you REALLY LOVE that environment and really want to take a few weeks to learn the residents, their meds, etc, and unless you absolutely HAVE no other work option, then leave. I DID leave LTC for the reasons you alluded to: staff's lack of quality time for the residents, neglect by the CNAs,constant OT(whcih was usually unpaid because the DON said she'd not pay OT)because the work cannot be done in 8 hrs, lack of time to do proper assessments, etc. I felt that my license was in jeopardy all the time....and many other nurses left due to the same feeling. Examine the pros and cons for yourself then decide.

[leeae85]

I can kind of sympathize with you 1st Edition, I just started my FIRST job from nursing school @ at LTCF (I graduated in July 06). I will be working weekend nights baylor from 7p-7a, and i will have 44 patients (which by reading this forum isnt too bad), and 1st and 2nd shift have 22 patients. The facility also has a nurse that does ALL the dressing changes, and i only have 3 tube feeders, and only 5 that needs charting everyday. I know it can be a LOT worse. I just hope i have a great team to work with at night. Let us know how you do 1st Edition!

[speti4]

I work in a med/surg unit and occasionaly on call in Extended care where

I have 39 residents. The med passes take most of the time..There are so many meds in that unit it boggles my mind.

I have a few wounds to dress. I change the odd catheter. I do very few assessments per shift, sometimes none as they are in their homes, not the hospital. I communitcate via the fax for orders, etc.

I don't like the environment, but I usually manage to get my work done by shift end.

Some days it feels like I am running around putting out fires rather than being productive. Ah well... I have days like that on med/surg with 4 pts.

[dlsgroovymom]

freg

[TheCommuter, BSN, RN]

My advice...do not let them rush you through an orientaition. And do not let any CNA's intimidate you. Good Luck!

This is true. Many CNAs actually 'run things' at certain facilities. They can make your work experience pleasant or, unfortunately, make it a living hell for you.